Job Abstract

Utilization Case Manager Care Coordination Full Time

POSITION SUMMARY:

Performs concurrent utilization review activities on all patients within the assigned caseload. Collaborates and educates the medical staff on appropriate utilization review guidelines and documentation in accordance with CMS regulations and Commercial payors guidelines. Monitors and intervenes on LOS, resource utilization and denial management/ prevention within the assigned caseload.

EDUCATION:

Bachelor,s degree (BSN) in nursing required.

EXPERIENCE:
Minimum 5 years experience in clinical nursing, minimum of 3 years in case management/ utilization.

SPECIAL SKILLS:
Registered Nurse, Licensed in State of New Jersey, Current acute care clinical knowledge with broad-base medical / surgical background. Demonstrates effective interaction and communication skills. Strong critical thinking, clinical reasoning skills and effective problem-solving. Ability to perform work accurately and pay attention to details, often changing from one task to another without loss of efficiency or composure. Ability to function competently in stressful situations and changing work environment, Ability to work collaboratively within the health- system with patients and families; and with multidisciplinary team members.

Area of Talent: Allied Health & Technical

Organization: The Valley Hospital

Department: VH CASE MGMT/SOCIAL SVC

Shift: Day

Status: Full Time (36+ hrs/week)

Schedule: 8:00 am - 4:30 pm

req15380

United States